Static and Dynamic Patient Characteristics as Predictors of Criminal Recidivism: A Prospective Study in a Dutch Forensic Psychiatric Sample

If clinicians in forensic psychiatry want to reduce risk of reoffending in their patients, they require insight into dynamic risk factors, and evidence that these add predictive power to static risk indicators. Predictors need to be evaluated under clinically realistic circumstances. This study aimed to validate dynamic and static variables as predictors of reconviction in a naturalistic outcome study. Data on static and dynamic risk factors were collected for 151 patients discharged from Dutch forensic psychiatric hospitals. Community follow-up was prospective, with a 5.5 year minimum. A prediction model was developed using Cox regression analysis. The magnitude of the predictive power of this model was estimated using receiver operating characteristic (ROC) analysis. The final prediction model contained four static and no dynamic predictors. The model's ROC area under the curve was .79 (95% CI .69–.89). Clinical risk ratings were non-predictive. Post hoc analyses exploring the influence of subgroups of patients did not yield better models. It is concluded that a small set of static predictors yielded a good estimate of future reconvictions; inclusion of dynamic predictors did not add predictive power.     

Predictive Validity of the SVR-20 and Static-99 in a Dutch Sample of Treated Sex Offenders

In this retrospective study, the interrater reliability and predictive validity of 2 risk assessment instruments for sexual violence are presented. The SVR-20, an instrument for structured professional judgment, and the Static-99, an actuarial risk assessment instrument, were coded from file information of 122 sex offenders who were admitted to a Dutch forensic psychiatric hospital between 1974 and 1996 (average follow-up period 140 months). Recidivism data (reconvictions) from the Ministry of Justice were related to the risk assessments. The base rate for sexual recidivism was 39%, for nonsexual violent offenses 46%, and for general offenses 74%. Predictive validity of the SVR-20 was good (total score: r = .50, AUC = .80; final risk judgment: r = .60, AUC = .83), of the Static-99 moderate (total score: r = .38, AUC =.71; risk category: r = .30, AUC = .66). The SVR-20 final risk judgment was a significantly better predictor of sexual recidivism than the Static-99 risk category.     

暴力危险量表中文版的信度

目的引入、修订具有评估暴力危险及危险变化的暴力危险量表(Violence Risk Scale,VRS),对修订后的暴力危险量表中文版(VRS-C)进行信度检验。方法通过标准的翻译程序形成VRS-C,3位评估者独立评估14个案例以检验评分者信度,以125例来自成都安康医院监管病区、四川华西法医学鉴定中心法医精神病学教研室及华西心理卫生中心的精神疾病患者为被试,对VRS-C的信度进行检验。结果初步修订的VRS-C具有较好的评分者信度(ICC=0.80)、同质性信度(克朗巴赫α系数=0.921)、分半信度(0.906)及题总相关性(0.246～0.849)。结论初步修订的VRS-C具有较好的信度。     

劳动争议案件司法精神病鉴定研究

目的探讨劳动争议案件的司法精神病鉴定的现状及发展趋势。方法回顾性分析1990～2001年156例劳动争议案件司法精神病鉴定中的被鉴定人一般资料、案由、委托方、鉴定时机、病史、鉴定结论等情况。结果44.2%的被鉴定人处于30～39岁,委托方多为法院(68.6%),大多数案件由家属和法院申请鉴定;终(中)止合同的案件占75.7%,劳动报酬的案件大幅度上升;争议起始至申请鉴定平均相距21.9个月,12个月以内的占69.2%;鉴定诊断精神分裂症82例(51.3%),无精神病16例(10.2%),结论与既往临床诊断一致的占91.2%;评定为有、限制、无行为能力的比例分别为23.7、23.1和52.6%。结论近年来劳动争议案件在数量、案由、鉴定时机等方面发生较大变化,有关民事行为能力的评定应引起司法精神病学界关注。     

精神病人限定刑事责任能力评定量表信效度多中心研究

目的对自行研制的《精神病人限定刑事责任能力评定量表》的信效度进行多中心研究。方法：在国内四地七家精神疾病司法鉴定机构取样,对被评定为限定责任能力的案例按量表手册进行评分,并与各中心鉴定专家按辨认能力和控制能力受损大小将限定刑事责任能力所作的三级划分进行比较。结果共纳入702例案例,根据专家意见限定责任能力分为三级：小部分责任能力组、部分责任能力组和大部分责任能力组。小部分、部分和大部分组量表均分分别为21.32±3.85、25.91±5.69和29.54±5.19,差异具有统计学意义;量表各条目与总分相关系数在0.27～0.61之间,再测信度为0.85,评分者一致性kappa在0.5～0.91之间;主成分分析提取六个因子,累积贡献率为67.26%,主要反映被鉴定人的作案预谋、作案动机、作案后的行为表现、反映精神疾病对被鉴定人自我状态和社会功能的影响、案发前被鉴定人面临的环境及其反应程度;判别分析显示,作案动机、对作案时间的选择性、作案后逃避责任、检验或审讯时伪装、对作案行为的罪错性认识、自知力损害和自控能力损害纳入判别式,回代正确率为62.3%。结论《精神病人刑事限定责任能力评定量表》构建合理,有较好的信效度。     

司法精神医学鉴定无精神病74例案例分析及随访

目的探讨司法精神医学鉴定中无精神病案例的特点及转归。方法对74例无精神病案例进行随访,并统计分析有关资料。结果无精神病案例占鉴定总数的5.7%。被鉴定人作案动机明确,自我保护良好,鉴定后“精神症状”消失。结论多因素综合分析有助于无精神病案例的司法鉴定,应特别注意精神分裂症早期症状的识别,防止误诊。     

Assessing change in dynamic risk factors in forensic psychiatric inpatients: relationship with psychopathy and recidivism

This study explored change in dynamic risk for violence using the Clinical and Risk Management subscales of the Historical Clinical and Risk Management-20 version 3 (HCR-20 v3) and sought to determine whether change was associated with violent recidivism. The association between the magnitude of change and psychopathy was also assessed. Participants were 40 male (n = 32) and female (n = 8) forensic psychiatric inpatients discharged from a secure forensic mental health service. Results showed that participants significantly improved on the HCR-20v3 Clinical subscale but significantly worsened on the Risk Management subscale. Psychopathy was unrelated to change in Clinical and Risk Management subscales. The hypothesis that changes in dynamic risk would predict recidivism over and above total pre-treatment risk (HCR-20v3 Total score) and psychopathy was not supported. These results suggest that improvements in mental state risk factors alone are insufficient with regard to lowering violence risk.     

72例情感性精神障碍司法精神病鉴定分析

目的 探讨情感性精神障碍患者作案特征.方法 对杭州市公安局安康医院2000-2004年鉴定的72例情感性精神障碍案例进行分析.结果 情感性精神障碍患者作案与发作次数有一定关联性,躁狂症与抑郁症危害行为有统计学意义(P<0.01).情感性障碍患者作案特征与精神分裂症不同,主要是作案的病理性动机较少,现实动机较多.结论 反复发作是情感性精神障碍患者作案的预警性指标.在作案特征上与精神分裂症有各自不同的特点,可能与病因、病情发展、症状表现和严重程度等差异有关.     

Meta-analytically quantifying the reliability and biasability of forensic experts

Abstract:  In this paper we employ meta-analytic procedures and estimate effect sizes indexing the degree of reliability and biasability of forensic experts. The data are based on within-expert comparisons, whereby the same expert unknowingly makes judgments on the same data at different times. This allows us to take robust measurements and conduct analyses that compare variances within the same experts, and thus to carefully quantify the degree of consistency and objectivity that underlie expert performance and decision making. To achieve consistency, experts must be reliable, at least in the very basic sense that an expert makes the same decision when the same data are presented in the same circumstances, and thus be consistent with themselves. To achieve objectivity, experts must focus only on the data and ignore irrelevant information, and thus be unbiasable by extraneous context. The analyses show that experts are not totally reliable nor are they unbiasable. These findings are based on fingerprint experts decision making, but because this domain is so well established, they apply equally well (if not more) to all other less established forensic domains.     

限定刑事责任能力评定量表扩展应用的信效度

目的探讨限定刑事责任能力评定量表在责任能力评定中的扩展运用价值。方法采用DCRRS（内容包括现实作案动机,先兆,诱因,时间、地点、对象、工具选择,作案时情绪反应,作案后各种行为表现,生活自理能力、工作学习能力、自知力、现实检验能力损害和自我控制能力等）对108例符合要求的患者进行评定并与专家鉴定结果进行比较。结果DCRRS各条目间及其与总量表分间的相关均具有统计学意义（r=0.145～0.944,P〈0.001）,分半信度为0.868。根据DCRRS参考划界分分组,无、限定和完全责任能力3组间及两两间量表总分均具有显著统计学差异（P〈0.001）。DCRRS与专家鉴定结果一致性较高（Kappa=0.958,P〈0.001）,经判别方程回代具有较高的正确率（97.2%）。结论DCRRS的信效度良好,可作为辅助参考使用。     

电子数据司法鉴定工具可靠性评估研究

探讨建立对电子数据司法鉴定工具进行科学性及可靠性的评估方法。在已有的国内外取证工具评测方法的基础上,借鉴国家强制认证认可和可靠性工程等因素,对电子数据司法鉴定工具可靠性评估体系中的工具基本认可和定性评估二阶段进行详细分析,为保证司法鉴定实践的科学性和准确性提供理论依据。     

简易精神症状自陈量表对主观夸大精神症状的测试分析

目的 应用简易精神症状自陈量表检测法医精神鉴定中主观夸大精神症状的情况,并分析其测试结果。方法 对206名不同类型的法医精神鉴定的被鉴定人用该量表进行检测．并由两名鉴定专业人员对被鉴定人是否有主观夸大精神症状分别进行评定。结果 （1）以该量表判断主观故意或夸大精神症状的划界分（13分）对测试的被鉴定人进行检测,206例被鉴定人中有71例被判定为主观夸大精神症状（34．5％）。与专家评定的结果相比,量表评定的假阴性为19．8％,假阳性率为1．7％;总准确率为90．8％。（2）工伤和交通事故精神伤残理赔鉴定案例主观夸大精神症状的比例较高（51％）。结论 简易精神症状自陈量表是检测主观夸大精神症状的有效评定工具。     

道路交通事故所致精神损害的法医学评价

目的研究RTA所致PTSD的相关法医学问题,为司法实践中精神损害赔偿提供科学依据和司法建议。方法对156例因RTA申请伤残程度鉴定的被鉴定人,通过临床精神病学检查确定PTSD的诊断,法医临床学检查评定躯体损伤的伤残程度,并通过问卷调查进一步确定受害人的心理社会状态。结果156例被调查对象PTSD发生率为51.92%。男女PTSD的发生率具有统计学的显著性差异;随着伤残程度的严重性增加,发生PTSD的可能性也随着增加;PTSD组与非PTSD组在生活质量总均分和生理、心理、社会关系、环境四个维度以及焦虑、抑郁的各项得分中都有显著性差异;获得赔偿将明显降低PTSD的发生率。结论RTA作为创伤性事件,申请赔偿的RTA受害人存在较高的PTSD发生率,获得良好的赔偿可以明显地降低申请赔偿的RTA受害人PTSD的发生率。     

酒精相关违法行为的犯罪学特点分析

目的探讨法医精神病学鉴定中两种酒精相关违法行为的犯罪学特征。方法采用自行编制的法医精神病学鉴定案例登记表,对符合本研究纳入标准的90名被鉴定人分为普通醉酒(63例)和慢性酒精中毒(27例)两组,采用统计描述和对照研究的方法进行分析。结果普通醉酒组54.0%的案前有诱发事件,慢性酒精中毒组案前有诱发事件的为22.2%;58.7%普通醉酒组作案是临时确定的作案动机,55.6%慢性酒精中毒组无明显的作案动机;66.6%普通醉酒组是临时确定的作案目标,51.8%慢性酒精中毒组无明确的作案目标。普通醉酒组19.0%对作案时间做出了选择,慢性酒精中毒组织有3.7%选择了作案时间;普通醉酒组61.9%的案后有一定的反侦查手段,慢性酒精中毒组则是有59.3%案后停留现场。普通醉酒组98.4%被评为有刑事责任能力,慢性酒精中毒组仅3.7%被评为有刑事责任能力。结论普通醉酒组案前有诱发事件和作案动机的要高于慢性酒精中毒组,慢性酒精中毒组在案中和案后更多地缺乏自我保护意识。普通醉酒组更多地被评为有刑事责任能力,慢性酒精中毒组则多被评为部分刑事责任能力或无刑事责任能力。     

修订版外显攻击行为量表用于精神疾病患者危险行为评估

目的 探讨修订版外显攻击行为量表(Modified Overt Aggression Scales,MOAS)对精神疾病患者危险行为评估的价值.方法 采用MOAS对隶属公安、卫生、民政系统的3家精神卫生机构(安康监管病区、华西心理卫生中心、德康救治病区)共490名精神疾病患者根据痛史资料进行评估. 结果 无危险行为31...     

Patient perceptions of schizophrenia in forensic and general adult psychiatry

This study explores the illness perceptions of patients with schizophrenia in forensic settings and contrasts their views with those of a general adult psychiatry sample. It was hypothesised that forensic psychiatric patients would have more negative illness beliefs than general adult patients. A cross-sectional survey was used. Forty forensic patients and 32 general adult patients with schizophrenia were recruited. They completed the Illness Perception Questionnaire for Schizophrenia (IPQS), a valid and reliable measure of illness perceptions in mental health problems. Forensic patients perceived their illness to be less chronic, less cyclical, and had a lower negative emotional response to illness. Our results did not support our original hypothesis and possible reasons are explored. Acknowledging patient’s views when formulating management plans could permit more effective individually tailored treatment.     

Reassessing the reliability and validity of self-report delinquency measures

Several issues related to the reliability and validity of self-report delinquency measures are raised and discussed. These include problems associated with the use of internal consistency as the measure of reliability, the level of reliability or precision required for different types of analyses, problems with the content validity of self-report measures, problems of overreporting and underreporting, problems with the use of official records as a validity check on self-reports, and the lack of any good criterion as a major obstacle in assessing the empirical validity of self-report measures. In the light of these problems, some cautions about the use of self-report measures are made.